摘要:

Residual disease was identified in the hysterectomy specimen in 19 of 65 patients (29%) previously found to have cervical intraepithelial neoplasia and in four of 19 (21%) found to have early stromal invasion on histologic examination of a cone biopsy. Residual disease was found in six of 34 cases (18%) of cervical intraepithelial neoplasia and zero of 12 cases of early stromal invasion after complete excision, and in 13 of 31 cases (42%) of cervical intraepithelial neoplasia and four of seven cases (57%) of early stromal invasion after incomplete excision by cone biopsy. Sixteen of 28 women (57%) with abnormal cytology after cone biopsy were found to have residual disease at the time of hysterectomy. In contrast, no residual disease was found in 35 patients who had no evidence of cytologic abnormality after the initial treatment. The finding of abnormal cytology after cone biopsy is shown to be a more useful prognostic indicator than histologic examination of excision margins. Therefore, we believe that a policy of expectant management, based on regular cytologic examination, is justified when histologic assessment has shown the lesion to extend to the line of excision.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Whole-blood serotonin levels in 14 subjects with well documented premenstrual syndrome and 13 age-matched controls were compared. Serotonin levels of premenstrual syndrome subjects were significantly lower during the last ten days of the menstrual cycle. No significant differences were noted in levels of serum estradiol and progesterone. Decreased serotonin is known to be associated with depression in humans, and nonhuman primates have exhibited abnormal behavioral profiles when given serotonin antagonists. The present observation suggests that the physiologic basis of premenstrual syndrome involves an alteration in serotonin metabolism.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A radiologic method for measuring skin thickness and metacarpal index was used to investigate 41 postmenopausal women treated with estradiol (100-mg) subcutaneous implants (Organon, UK). All the women completed the first six months of the study, and 33 completed one year. Both skin thickness and metacarpal index increased to a statistically significant degree over the one-year period, with most of the increase occurring in the first six months of therapy. Skin thickness showed the largest increases, from a mean of 0.86 mm at the start of the study to 0.97 mm at six months and 1 mm at one year. The metacarpal index increased from a mean of 0.77 at the start of the study to a mean of 0.799 and 0.8 at six months and one year, respectively.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Recurrent idiopathic anaphylaxis is an illness consisting of recurring anaphylactic or anaphylactoid attacks of unknown cause. A patient has been described whose attacks appeared to be associated with endogenous progesterone secretion and who was treated successfully with an analog of luteinizing hormone-releasing hormone (LHRH). This report summarizes the treatment of four additional women with recurrent anaphylaxis in a randomized, double-blind trial of an LHRH agonist and placebo. Two out of the four women experienced remission of their symptoms with the LHRH analog. The patients who responded to therapy had experienced systemic anaphylactoid reactions after provocation with an LHRH infusion and the intradermal injection of medroxyprogesterone; the nonresponders had no adverse reactions to either challenge. Ovarian suppression with LHRH agonist may benefit a subset of women with recurrent idiopathic anaphylaxis.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

This paper summarizes our experience from 1972–1985 with the changing tools used in the diagnosis of ectopic preg nancy. The study was divided into three time periods based on the diagnostic methods used in each. In the first period (1972–1975), diagnosis was by culdocentesis and the urine pregnancy test. In the second period (197619781, diagnostic laparoscopy was added. Finally, in the third period (1979–19851, serum beta-human chorionic gonadotropin (p hCG) assay and pelvic ultrasonography were added. A rising trend in diagnostic accuracy was observed from the first period to the third. The predictability and the negative predictive value of diagnostic tests in the third period were 96.3 and 94.9%, respectively-significantly higher than in the first and second periods. The incidence of unruptured tubal pregnancy increased significantly, from 27.6% in the first and the second periods to 42.5% in the third period. Laparoscopy, ultrasonography, and serum PhCG assay each revealed a positive rate of more than 90% in the diagnosis of tubal pregnancy. Laparoscopy had the highest positive predictive value as a single test in the third period. Among suspected cases, however, laparoscopy was found to have a low accuracy in discriminating between tubal preg nancy and infection. The combination of serum p-hCG testing and ultrasonography produced a 99% positive pre dictive value, and revealed a higher degree of accuracy in the diagnosis of tubal pregnancy than any other single test or combination of tests.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

From 1982–1986, 625 tubal ectopic pregnancies were treated at the University of Hawaii School of Medicine Affiliated Hospitals. The percentage of cases in which the involved tube was preserved increased from 7% in 1982 to 26% in 1986. The presence of persistent trophoblastic tissue was diagnosed by elevated serum levels of the beta subunit of human chorionic gonadotropin (P-hCG) after conservative surgery in four patients. Three of the four patients developed intra-abdominal hemorrhage and required laparotomy. One patient remained asymptomatic despite elevated PhCG levels, which disappeared 60 days after surgery. Evaluation of histologic slides demonstrated persistent intraluminal trophoblastic tissue without invasion in two patients, and extraluminal invasion into the tubal wall in one patient. The use of postoperative serial PhCG titers might facilitate recognition of this complication in time to prevent further tubal damage and hemorrhage.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Eleven percent of the 272 women aged 2545 years admitted consecutively to a neurologic department in 1980–1984 had undergone hysterectomy. The population was divided into two groups according to the discharge diagnoses. Among women with discharge diagnoses usually associated with no objective neurologic findings, the frequency of hysterectomy was 14%, compared with 5.4% in women discharged with diagnoses indicating organic neurologic disease. Gynecologic and psychiatric admissions were more frequent in the former than in the latter group. Of the 30 hysterectomized women, only six had had malignant or premalignant changes in the uterus, whereas in 22 cases the removed organs had been normal. These results suggest that a somatization disorder might have been the underlying cause for the hysterectomy as well as for the symptoms and complaints leading to referral to the neurologic service. Awareness of this problem is important in order to avoid unjustified surgery.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Tissue specimens from 51 patients with genital condyloma acuminata or invasive cervical or vulvar carcinomas were analyzed for the presence of human papillomavirus deoxyribonucleic acid (DNA) using the dot blot technique. Of ten condylomas, 80% contained DNA related to human papillomavirus 6 or 11. Sixty percent had evidence of DNA related to human papillomavirus 16, and 30% contained DNA related to human papillomavirus 18. Of 24 squamous cervical carcinomas, 58% had human papillomavirus type 16-related DNA, 33% had type 6 or 11-related DNA, and 4% had type 18-related DNA. Nine primary or recurrent vulvar carcinomas were analyzed. Seventy-eight percent contained human papillomavirus type 6 or 11-related DNA, 33% type 16-related DNA, and 22% type 18-related DNA. Whereas invasive cervical carcinomas predominantly contained DNA related to human papillomavirus 16 or 18, invasive vulvar carcinomas predominantly contained DNA related to types 6 or 11. Thus, human papillomavirus type alone cannot distinguish benign from malignant epithelial disease in the female genital tract.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Seventeen previously unreported cases of clear-cell adenocarcinoma originating in the vagina (13) and cervix (four) are presented. The mean age of the patients was 23.6 years. Four patients with cervical tumors and four patients with vaginal tumors underwent radical hysterectomy, bilateral pelvic lymphadenectomy, and partial vaginectomy. A total vaginectomy, with replacement of the excised vagina with a split-thickness skin graft or a segment of sigmoid colon, was added to the above procedure in five patients with vaginal cancer. In four patients, definitive treatment was radiation. All of the patients in the present series are without evidence of disease, with follow-up ranging from 21 months to more than ten years.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Adnexal masses in postmenopausal women were reviewed according to size, pathology, age of the patient, and accuracy of ultrasound versus pelvic examination. Only one of 32 masses less than 5 cm in diameter was malignant. Of 55 masses 5–10 cm in size, six were malignant, including one lymphoma and two borderline tumors. Forty of 63 tumors larger than 10 cm were malignant. The proportion of malignancies increased with age. Pelvic examination missed 10% of tumors less than 10 cm in diameter. Of those palpated, the examination predicted the size of the mass to within 2 cm in 68% of cases. Ultrasonic prediction of size was accurate in 87% of cases scanned. Our findings cast doubt on the concept that all postmenopausal women with minimally enlarged ovaries should undergo laparotomy.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID